Abstract
Recurrent stroke is becoming an increasingly important public health issue owing to the increased risk of disability and death. However, population-based studies investigating the rate of recurrent stroke in China are rare. We explored the rate and determinants of recurrent stroke within 1 and 5 years after the initial stroke in a rural population in China. Data for stroke events were obtained from the Tianjin Brain Study, conducted between 1992 and 2016. The age-standardized rates of recurrent stroke within the first year and the first 5 years after the initial stroke were calculated for this period. Determinants of recurrent stroke were assessed using Cox regression analyses. The overall age-standardized rate of recurrent stroke within 1 year was 5.7% (men, 6.9%; women, 4.6%); within 5 years, the overall recurrent stroke rate was 22.5% (men, 24.0%; women, 20.2%). The recurrence rate increased with advancing age and decreased with increased educational attainment. Age ≥65 years and a history of alcohol consumption were independent risk factors for recurrent stroke within 1 year after the incident stroke, after adjusting for age, sex, education, hypertension, diabetes, smoking, and alcohol consumption. However, the risk of recurrent stroke within 5 years after the incident stroke was positively associated with male sex, age ≥65 years, a lower level of education, known diabetes, and alcohol consumption, after adjusting for the previously indicated covariates. These findings suggest a crucial need to address risk factor management among stroke patients to reduce the burden of stroke, especially among low-income populations. Furthermore, a multicenter, large sample, nationwide study is urgently needed.
Highlights
Stroke is one of the leading causes of death and disability, worldwide [1] and is responsible for ∼4.4 million deaths (9% of total) annually [2]
All 1,185 patients were included in the determination of the rate and associated predictors of recurrent stroke 1 year after the incident event; patients experiencing incident strokes between January 1, 1992, and December 31, 2012 (n = 899), were included in the determination of the 5 year recurrent stroke rate and its associated predictors
Between 1992 and 2016, 1,185 initial stroke events were included in this study; the mean time to the first recurrent stroke within the first year was 0.82 years; for the 5 year time frame, the mean time to recurrence was 3.08 years
Summary
Stroke is one of the leading causes of death and disability, worldwide [1] and is responsible for ∼4.4 million deaths (9% of total) annually [2]. Over the past two decades, there has been a notable increase (84%) in the absolute numbers of stroke survivors globally the incidence of stroke has decreased in high-income. There are ∼2.5 million new stroke cases reported in China, and currently there are ∼7.5 million stroke survivors; nationally, the stroke recurrence rate remains high (11.2%) [20]. Over the past few decades, the incidence of stroke has increased in China both in urban and rural populations [21,22,23,24,25]. Few populationbased studies have described the incidence of recurrent stroke in China, especially among rural populations. In this study, we aimed to assess the rate of recurrent stroke within 1 and 5 years after the incident stroke in rural China
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